A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study

Background Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.

Public Reactions to Noncompliance with Judicial Orders

Constitutions empower people to ask judges for binding orders directing state agents to remedy rights violations, but state agents do not always comply. Scholars propose that by making it easier to observe noncompliance, courts can leverage public pressure for compliance when it exists. Yet, exposure to information about noncompliance might lead individuals to accept high levels of noncompliance and reduce support for judicial remedies. We estimate the rate of noncompliance with judges’ orders via a rigorous tracking study of the Colombian tutela. We then embed this rate in three survey experiments fielded with online national quota samples. We show that people find the noncompliance rate in the tutela highly unacceptable regardless of a variety of mitigating factors. We also show that public reactions to this information depend on prior expectations, a finding that stresses the importance of scholarship in cognitive psychology for studies of compliance in law and politics.

An examination of retailers’ compliance with the minimum legal drinking (purchasing) age law in Slovenia: A quasi-experimental intervention study

Introduction Alcohol consumption among young people is strongly related to alcohol availability. The minimum legal drinking (purchasing) age (MLDA) is a legal measure that regulates alcohol availability to minors in Slovenia. This study examines (1) retailers’ compliance with the MLDA law in Slovenia and (2) the effectiveness of two interventions directed at cashiers in off-premise stores. Methods The study uses a non-randomized quasi-experimental design to evaluate the effectiveness of (1) a communication intervention directed at off-premise store managers, and (2) an intervention by the Slovene Market Inspectorate. The first intervention focused on informing cashiers about MLDA’s importance and their role as gatekeepers of young people’s health, while the second involved law enforcement. Using the mystery shopping protocol, we conducted two waves of purchase attempts with decoy underage shoppers pre- and post-intervention in 97 off-premise stores. We collected data on the shopping process at the point of sale and conducted 40 semistructured interviews with cashiers to evaluate the barriers and incentives regarding MLDA compliance. Results Retailers’ initial noncompliance rate with MLDA in off-premise stores was high, but improved significantly after the law enforcement intervention. We identified a significant correlation between the cashiers’ ID requests and the refusal of alcohol sales, but cashiers’ ID requests remained low. Qualitative findings reveal that cashiers experience several issues when handling MLDA in practice. Conclusion Noncompliance with MLDA persisted even after the law enforcement intervention, revealing the need for policy makers to introduce new strategies for MLDA enforcement, such as revocable alcohol licenses for off-premise stores.

A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study (Preprint)

BACKGROUND Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. OBJECTIVE This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. METHODS Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. RESULTS A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; <i>P</i>=.007); no significant difference was found in the App nonused cohort (<i>P</i>=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; <i>P</i><.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; <i>P</i>=.04), but not for anti-HER2 therapy (<i>P</i>=.76) or endocrine therapy (<i>P</i>=.39). CONCLUSIONS This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy.

Self-Quarantine Noncompliance During the COVID-19 Pandemic in South Korea

ABSTRACT Objectives: In South Korea, many individuals were self-quarantined for the coronavirus disease 2019 (COVID-19) after the quarantine criteria were extended to all overseas travelers. This study was conducted to identify the noncompliance rate of self-quarantine for COVID-19 cases and assess the impact of a 1-strike out policy and an increased amount of penalty for the violating self-quarantine in South Korea. Methods: The self-quarantine noncompliance rate for COVID-19 was examined using publicly available data. We collected the daily number of quarantine and quarantine violation cases from March 22 to June 10, 2020. A Poisson regression analysis was conducted to identify the impact of additional sanctions for the quarantine violation. Results: The median number of individuals quarantined per day was 36,561 (interquartile range, 34,408-41,961). The median number of daily self-quarantine violations was 6 (range, 0-13). The median rate of self-quarantine violations was 1.6 per 10,000 self-quarantined individuals (range, 0.0-8.0 per 10,000 self-quarantined individuals). The additional sanction has no significant impact on the number of violations among quarantine individuals (P = 0.99). Conclusions: The additional sanction for the violation of quarantined individuals did not reduce the self-quarantine violations. Further studies are warranted to strengthen the compliance of self-quarantine for future pandemics.

Foot abduction brace noncompliance in children with idiopathic clubfoot: how the deep squatting posture might help

Background. Compliance with the foot abduction brace (FAB) is essential for idiopathic clubfoot (ICF) managed by the Ponseti method. The deep squatting posture (DSP) was correlated with favorable outcomes in ICF. Aim. The aims of the study were to identify the noncompliance rate with the FAB, and assess how the routine practice of ankle stretching and Asian-style DSP affected the ICF correction during the Ponseti method. Materials and methods. Of 42 children with ICF, 63 ICF underwent the Ponseti method at an average age of 8.7 12.6 weeks using an average of 5.4 1.7 casts followed by FAB wear. The children practiced the DSP exercise as an adjunct to the FAB protocol. Children noncompliant with the FAB protocol but compliant with the DSP exercise (group A) were compared with children noncompliant with both FAB protocol and DSP exercise (group B). Results. At an average follow-up of 3.5 1.4 years, 8 of 42 children compliant with the FAB protocol. The FAB protocol deviation was documented at an average of 10.3 4.8 months. Children who did not adhere to the practice of the DSP exercise had a higher recurrent rate of any ICF deformity (OR 7.82, 95% CI 1.3553.79, p = 0.003). Of the 34 children (48 feet) noncompliant with FAB, the children in group A (39 feet) had lower recurrence rate (p = 0.02), a better Dimeglio grade (p = 0.005), and a better Pirani score (p 0.001) at the most recent evaluation than children in group B (nine feet). However, recurrent metatarsus adductus was more prevalent in group A. Conclusion. The DSP exercise should be advocated as a supplemental modality but cannot substitute the regular use of FAB.

Comparing Moral Hazard Behaviour of Micro and Small Enterprises on Productive Business Loan Repayment

<p>This research aims to measure and compare the moral hazard behaviour of micro and small enterprises’ debtors within Purwokerto area on Productive Business Loan scheme. This scheme was choosen because of the highest Non Performing Loan (NPL) among others. The data were collected from 127 debitors by using simple random sampling technique. Rating scale method was used to measure the moral hazard behaviours of debtors through questionnaire and later comparing them to study how serious the noncompliance rate in repaying off their credits. This research finds that (1) Generally, the moral hazard behaviour tends to be medium-to-high, (2) The highest moral hazard should be attributed to debitors in Purbalingga followed by those in Banjarnegara, Purwokerto, and Cilacap. Then, it suggests that (1) all bank branches need to pay more attentions to their debitors because their moral hazard behaviours have been medium-to-high. (2) Each branch needs to apply specific treatments to the debitors to improve debitors’ installments, i.e building lending relationship as one way of exploring soft information which emphasizes informal approaches, (3) It should be important to design integrated training and practices for bank officers in order to build up their sense of psychological skills in public relationship in order to handle, in turn, those risky debtors.</p>

Trust in scientists and rates of noncompliance with a fisheries rule in the Brazilian Pantanal

Natural resource rules exist to manage resources and the people that interact with them. These rules often fail because people do not comply with them. Decisions to comply with natural resource rules often are based on attitudes about legitimacy of rules and the perceived risks of breaking rules. Trust in agencies promulgating rules in part may determine perceptions of legitimacy of the rule, and in turn depends on individuals’ trust in different agency actors. The purpose of this research was to explore the relationship between fishing rule noncompliance and trust in scientists, a key group within management agencies. We interviewed 41 individuals in one rural fishing community in the Brazilian Pantanal from April to August, 2016, to assess (1) noncompliance rates, (2) noncompliance-related attitudes, and (3) the relationship between trust in scientists and noncompliance decisions in the region. We found that among study participants, noncompliance was common and overt. Trust in scientists performing research in the region was the best predictor of noncompliance rate with a fishing rule (nonparametric rank correlation ρ = −0.717; Probit model pseudo-R2 = 0.241). Baseline data from this research may help inform future interventions to minimize IUU fishing and protect the Pantanal fishery. Although our results are specific to one community in the Pantanal, trust in scientists is potentially an important factor for compliance decisions in similar situations around the world. These results build not only on compliance theory but also speak to the important role that many scientists play in the geographic areas in which they conduct their research.